CMS Comprehensive Primary Care Initiative

The Centers for Medicare and Medicaid Services (CMS) announced on June 6, that 45 commercial, federal and state insurers in seven geographic markets (Arkansas, Colorado, New Jersey, New York – Capital District-Hudson Valley region, Ohio and Kentucky – Cincinnati-Dayton region, Oklahoma – Greater Tulsa region, and Oregon) will work with CMS to enhance payment to primary care practices that provide high-quality care at lower cost for 4 years.

Under the Comprehensive Primary Care Initiative (CPCI), CMS will select 75 primary care practices in the seven designated markets and pay them a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Participating commercial, state, and other federal insurance plans in the seven markets will also offer enhanced payment to primary care practices that provide high-quality primary care.

According to the CMS, in order to receive the new care management fee from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients’ other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

Primary care groups interested in participating in this program must submit an application by 5:00PM EDT on July 20. The first step in the application process is to complete the application pre-screening tool, available at: https://cmsgov.secure.force.com/cpci/cpciscreening.

If you would like to learn more about the initiative before applying, please see the information below on a recent webinar and upcoming regional conference calls.

On June 19th, the CMS Innovation Center held a national webinar that outlined the initiative in detail, including the service delivery model (i.e., the 5 Comprehensive Primary Care functions and the milestones participating practices will need to achieve in the first year), as well as the application process. This webinar was recorded and will be available on the CMS Innovation Center website shortly (http://innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html). ACP also hosted a national call with the CMS Innovation Center staff on May 23rd—a recording of this call, along with the slides used for the presentation are available at: http://www.acponline.org/cpci.

In addition, ACP is collaborating with the CMS Innovation Center staff, as well as AAFP and AOA, to hold a conference call series the week of June 25. The program objectives for these calls are to outline: key initiative highlights, eligibility requirements, application details, and resources and tools to assist your practice. The bulk of the call will be dedicated to addressing questions and answers by interested practices.